title: An application of outcomes monitoring for coronary artery bypass surgery 2005-2008 at TPCH.
abstract: OBJECTIVE
  To describe monitoring of four years' isolated coronary artery bypass surgery outcomes and complications at The Prince Charles Hospital, Brisbane, Australia.
  
  
  METHODS
  Analysis of Cardiac Surgical Register database using tabulations, funnel plots and random-effects (Bayesian shrinkage) analysis for aggregated data. Combined CUSUM and cumulative observed minus expected (modified VLAD) charts and combined CUSUM and cumulative funnel plots used for individual observation sequential data and binomial control charts and generalised additive models (GAMs) for quarterly sequential data. Risk adjustment employed re-calibrated EuroSCORE.
  
  
  RESULTS
  There were 2575 procedures with an unadjusted in-hospital mortality rate of 1.17%. Mean age was 65 years and 21% of patients were female; 43.6% were elective procedures. Median ventilation time was 10 hours and median length of stay in intensive care (ICU) was 23 hours. Return to theatre for bleeding occurred in 3% of cases. Return to theatre for surgical site infection occurred in 0.4% of cases; 4% were re-do procedures. Permanent stroke or neurological deficit occurred in 1%, perioperative myocardial infarction in 0.8%, arrest in 1.2%, renal failure in 1.6% and ICU return in 2.3% of cases.
  
  
  CONCLUSIONS
  Complication rates and mortality were comparable with similar units. Use of random-effects (Bayesian shrinkage) analysis for aggregated data is encouraged together with generalised additive models (GAMs) and combined CUSUM and cumulative observed minus expected (modified VLAD) charts for sequential data.
authors.affiliation: Department of Cardiac Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia. amor5444@bigpond.net.au
authors.forename: Anthony Park
authors.initials: AP
authors.lastname: Morton
authors.forename: Susan Erica
authors.initials: SE
authors.lastname: Smith
authors.forename: Daniel V
authors.initials: DV
authors.lastname: Mullany
authors.forename: Andrew J B
authors.initials: AJ
authors.lastname: Clarke
authors.forename: Douglas
authors.initials: D
authors.lastname: Wall
authors.forename: Peter
authors.initials: P
authors.lastname: Pohlner
mesh_terms: D001315:Australia; D001026:Coronary Artery Bypass; D003422:Critical Care; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007431:Intraoperative Complications / Q000401:mortality*; D007902:Length of Stay; D008297:Male; D008991:Monitoring, Physiologic; D012042:Registries; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors